帕金森综合征PET/MR同步采集18F-FDG显像与ASL脑血流灌注成像相关性及鉴别诊断价值  

Correlation and differential diagnostic value of 18F-FDG imaging and arterial spin labeling cerebral perfusion imaging acquired by synchronous PET/MR in Parkinsonism

作　　者：孙逊[1,2] 刘芳 阮伟伟[1,2] 黄小娟 王涛 胡波 兰晓莉[1,2] Sun Xun;Liu Fang;Ruan Weiwei;Huang Xiaojuan;Wang Tao;Hu Bo;Lan Xiaoli(Department of Nuclear Medicine, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China;Hubei Key Laboratory of Molecular Imaging, Wuhan 430022, China;Department of Neurology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China)

机构地区：[1]华中科技大学同济医学院附属协和医院核医学科,武汉430022 [2]分子影像湖北省重点实验室,武汉430022 [3]华中科技大学同济医学院附属协和医院神经内科,武汉430022

出　　处：《中华核医学与分子影像杂志》2019年第6期337-343,共7页Chinese Journal of Nuclear Medicine and Molecular Imaging

基　　金：国家自然科学基金(81701759);湖北省技术创新重大项目(2017ACA182).

摘　　要：目的分析PET/MR同步采集18F-脱氧葡萄糖(FDG)显像与动脉自旋标记脑血流灌注加权成像(ASL-PWI)间的相关性,并探索18F-FDG PET显像与ASL技术对帕金森综合征的鉴别诊断价值。方法回顾性分析2017年10月至2018年12月行18F-FDG PET/MR成像的24例帕金森病(PD)患者、10例多系统萎缩(MSA)患者和6例进行性核上性麻痹(PSP)患者(男15例、女25例,年龄34~77岁),提取其同步采集的MRI T1、18F-FDG PET和三维ASL-PWI数据,利用T1图像与标准脑分区模板配准获得患者个性化脑分区模板,进而匹配至患者PET和ASL-PWI图像,提取各脑区的平均标准摄取值(SUVmean)和平均脑血流量(CBFmean)。采用Pearson相关分析评价SUVmean与CBFmean的相关性及其在感兴趣脑区(尾状核、壳核、中脑、脑桥及小脑)的相关性;采用单因素方差分析与最小显著差异t检验评价各感兴趣脑区SUVmean及CBFmean在3组病变间的差异;采用受试者工作特征(ROC)曲线分析评估各感兴趣脑区SUVmean及CBFmean的鉴别诊断价值。结果3组40例患者共获得2 800对SUVmean和CBFmean,两者整体相关性良好(r=0.468, P<0.01)。5个感兴趣脑区中尾状核、壳核、脑桥及小脑存在明显相关(r值:0.346~0.492,均P<0.05)。MSA组小脑CBFmean明显低于PD组[(36.92±11.35)与(47.92±10.75) ml·100 g-1·min-1;F=4.817,t=2.675,P<0.05],PSP组尾状核CBFmean低于PD组[(30.02±3.51)与(40.21±8.13) ml·100 g-1·min-1;F=5.393,t=2.969,P<0.05],与SUVmean的特征一致。小脑CBFmean鉴别PD和MSA的效能最高,ROC曲线下面积(AUC)、灵敏度、特异性分别为0.792、83.3%和70.0%;尾状核CBFmean鉴别PSP与PD及MSA的诊断效能最高,AUC分别为0.903和0.933。结论对于PD、MSA和PSP,18F-FDG PET/MR同步采集获得的葡萄糖代谢水平与ASL脑血流灌注量间的一致性较好,两者在特定感兴趣脑区的分布特点有助于帕金森综合征的鉴别诊断。Objective To discuss the correlation between 18F-fluorodeoxyglucose (FDG) imaging and arterial spin labeling perfusion weighted imaging (ASL-PWI) using synchronous PET/MR, and explore the feasibility of 18F-FDG PET and ASL for differential diagnosis in Parkinsonism (PS). Methods A retrospective analysis was performed in 24 patients with Parkinson′s disease (PD), 10 patients with multiple system atrophy (MSA) and 6 patients with progressive supranuclear palsy (PSP) who all underwent 18F-FDG PET/MR imaging from October 2017 to December 2018 (15 males, 25 females, age: 34-77 years). Synchronously acquired data, including MRI T1, 18F-FDG PET and three dimensional (3D) ASL-PWI were extracted. T1 structure image was used to register with standard brain template, and the personalized brain template of each patient was obtained. Then, the templates were matched to the corresponding PET and ASL-PWI images, and the mean standardized uptake value (SUVmean) and mean cerebral blood flow (CBFmean) of each brain region could be extracted. Pearson correlation analysis was used to evaluate the correlation between SUVmean and CBFmean of the whole brain and the regions of interest (ROI;caudate nucleus, putamen, midbrain, pons and cerebellum). One-way analysis of variance and least significant difference t test were used to evaluate the characteristics of SUVmean and CBFmean in different diagnostic groups. The diagnostic values of SUVmean and CBFmean in different ROI were evaluated with receiver operating characteristic (ROC) curve analysis. Results A total of 2 800 pairs of SUVmean and CBFmean were obtained from 40 cases in 3 groups. The overall correlation between them was good (r=0.468, P<0.01). There were also significant correlations between SUVmean and CBFmean in caudate nucleus, putamen, pons and cerebellum (r values: 0.346-0.492, all P<0.05). The CBFmean of cerebellum in MSA group was significantly lower than that in PD group ((36.92±11.35) vs (47.92±10.75) ml·100 g-1·min-1;F=4.817, t=2.675, P<0.05). Compared to the PS

关 键 词：帕金森障碍 正电子发射断层显像术 磁共振成像 诊断 鉴别 脱氧葡萄糖 

分 类 号：R742.5[医药卫生—神经病学与精神病学] R817.4[医药卫生—临床医学] R445.2